U.S. patent application number 11/144377 was filed with the patent office on 2006-03-23 for system and method for centralized management and monitoring of healthcare services.
Invention is credited to Richard Postrel.
Application Number | 20060064320 11/144377 |
Document ID | / |
Family ID | 36075181 |
Filed Date | 2006-03-23 |
United States Patent
Application |
20060064320 |
Kind Code |
A1 |
Postrel; Richard |
March 23, 2006 |
System and method for centralized management and monitoring of
healthcare services
Abstract
A centralized healthcare management and monitoring system and
service including a healthcare management server computer
interconnected to a computer network, having a first repository of
records with patient healthcare information and a second repository
with predetermined compliance rules with information regarding an
interaction between multiple entities associated with the
healthcare management server computer. Multiple healthcare provider
computers, associated with a healthcare provider, allow input of
patient identification indicia identification indicia presented by
a patient and communicating with the healthcare management server
computer over the computer network. A query is sent to the
healthcare management server computer that includes the patient
identification indicia; an identification of the healthcare
services performed or proposed to be performed by the associated
healthcare provider; and an identification of the healthcare
provider performing the healthcare services. The healthcare
management server computer then utilizes the query to access the
first and second repositories to determine if the parameters of the
query are in compliance with one or more of the predetermined
compliance rules.
Inventors: |
Postrel; Richard; (Miami
Beach, FL) |
Correspondence
Address: |
ANTHONY R. BARKUME
20 GATEWAY LANE
MANORVILLE
NY
11949
US
|
Family ID: |
36075181 |
Appl. No.: |
11/144377 |
Filed: |
June 2, 2005 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
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60576634 |
Jun 2, 2004 |
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Current U.S.
Class: |
705/2 |
Current CPC
Class: |
G16H 40/67 20180101;
G16H 10/65 20180101 |
Class at
Publication: |
705/002 |
International
Class: |
G06Q 10/00 20060101
G06Q010/00 |
Claims
1. A centralized healthcare management and monitoring system
comprising: a. a healthcare management server computer
interconnected to a computer network, the healthcare management
server computer comprising: i. a first repository of patient
records, each patient record associated with a patient and
accessible via a unique patient identification indicia associated
with the patient, each patient record comprising healthcare
information associated with the patient; and ii. a second
repository of predetermined compliance rules; each of the
compliance rules comprising information regarding an interaction
between multiple entities associated with the healthcare management
server computer; b. a plurality of healthcare provider computers
interconnected to the computer network, each of which is associated
with a healthcare provider, each of the healthcare provider
computers comprising means for inputting a patient identification
indicia presented by a patient and communicating with the
healthcare management server computer over the computer network
using the patient identification presented by the patient; wherein,
when a patient presents, in association with healthcare services
performed by the associated healthcare provider, a patient
identification indicia associated with the patient, the healthcare
provider computer transmits to the healthcare management server
computer a query comprising parameters comprising: the patient
identification indicia; an identification of the healthcare
services performed or proposed to be performed by the associated
healthcare provider; and an identification of the healthcare
provider performing the healthcare services; and the healthcare
management server computer utilizes the query to access the first
and second repositories to determine if the parameters of the query
are in compliance with one or more of the predetermined compliance
rules.
2. The system of claim 1 wherein the compliance rules comprise
rules related to healthcare treatment procedures, and wherein the
healthcare management server computer determines if the healthcare
services proposed to be performed by the healthcare provider
identified in the query are in compliance with the healthcare
treatment procedures.
3. The system of claim 2 wherein healthcare information associated
with the patient identified in the query is utilized by the
healthcare management server computer to determine if the
healthcare services proposed to be performed by the healthcare
provider identified in the query are in compliance with the
healthcare treatment procedures.
4. The system of claim 1 further comprising a healthcare insurer
computer associated with a healthcare insurance provider
interconnected to the computer network.
5. The system of claim 4 wherein the healthcare management server
computer obtains insurance information from the healthcare insurer
computer and utilizes the insurance information to determine if the
parameters of the query are in compliance with one or more of the
predetermined compliance rules.
6. The system of claim 5 wherein the insurance information
comprises information related to an insurance payment that the
healthcare insurance provider agrees to pay for the proposed
healthcare services.
7. The system of claim 6 wherein the insurance payment is made by
the healthcare insurance provider to the healthcare provider based
on the healthcare services rendered by the healthcare provider to
the patient.
8. The system of claim 1 wherein the compliance rules comprise
rules promulgated by a governmental agency.
9. The system of claim 1 wherein the compliance rules comprise
rules promulgated by a healthcare administrative agency.
10. The system of claim 1 wherein the healthcare provider computer
additionally retrieves from the healthcare management server
computer healthcare information associated with the patient and
presents the healthcare information.
11. The system of claim 1 further comprising a plurality of tokens,
each of which is associated with a patient, and each of which is
encoded with the unique identification indicia for identifying the
associated patient.
12. The system of claim 11 wherein the token is a healthcare
card.
13. The system of claim 12 wherein the healthcare card is a card
comprising a magnetic stripe encoded with the patient
identification indicia.
14. The system of claim 12 wherein the card is a smart card
comprising storage means for storing at least the patient
identification indicia.
15. The system of claim 11 wherein the token is an RFID device
capable of subdermal implantation.
16. The system of claim 1 wherein the healthcare provider computers
each comprise means for inputting data, wherein a. revised
healthcare information is entered into the means for inputting data
and transmitted to the healthcare management server computer, and
b. the record in the repository associated with the patient is
modified to include the revised healthcare information.
17. The system of claim 1 further comprising a third repository of
health points account records associated with each of the patients,
the health point account records containing a health point account
that indicates a number of health points that have been awarded to
the patient based on one or more of a plurality of health-related
criteria.
18. The system of claim 17 wherein health points are awarded to a
patient for participating in a positive health-related
activity.
19. The system of claim 17 wherein health points are awarded to a
patient for not participating in a negative health-related
activity.
20. The system of claim 17 wherein health points are awarded to a
patient for maintaining a predetermined level of health.
21. The system of claim 17 wherein multiples of health points are
accumulated in the health point account.
22. The system of claim 17 wherein a patient may redeem accumulated
health points from the associated health point account in exchange
for one of a plurality of available benefits.
23. The system of claim 17 wherein the plurality of available
benefits comprise reduced insurance premiums.
24. The system of claim 1 further comprising a third party
financial services entity interoperable with the healthcare
management server computer, said third party financial services
entity functioning to make payment to the healthcare provider based
on the healthcare services rendered by the healthcare provider to
the patient.
25. A method of operating a centralized healthcare management and
monitoring system comprising the steps of: a. providing a
healthcare management server computer interconnected to a computer
network, the healthcare management server computer comprising: i. a
first repository of patient records, each patient record associated
with a patient and accessible via a unique patient identification
indicia associated with the patient, each patient record comprising
healthcare information associated with the patient; and ii. a
second repository of predetermined compliance rules; each of the
compliance rules comprising information regarding an interaction
between multiple entities associated with the healthcare management
server computer; b. providing a plurality of healthcare provider
computers interconnected to the computer network, each of which is
associated with a healthcare provider, each of the healthcare
provider computers comprising means for inputting a patient
identification indicia presented by a patient and communicating
with the healthcare management server computer over the computer
network using the patient identification presented by the patient;
c. a patient presenting to a healthcare provider computer, in
association with healthcare services performed by the associated
healthcare provider, a patient identification indicia associated
with the patient, d. the healthcare provider computer transmitting
to the healthcare management server computer a query comprising
parameters comprising: i. the patient identification indicia; ii.
an identification of the healthcare services performed or proposed
to be performed by the associated healthcare provider; and iii. an
identification of the healthcare provider performing the healthcare
services; and e. the healthcare management server computer
utilizing the query to access the first and second repositories to
determine if the parameters of the query are in compliance with one
or more of the predetermined compliance rules.
26. The method of claim 25 wherein the compliance rules comprise
rules related to healthcare treatment procedures, and wherein the
healthcare management server computer determines if the healthcare
services proposed to be performed by the healthcare provider
identified in the query are in compliance with the healthcare
treatment procedures.
27. The method of claim 26 wherein healthcare information
associated with the patient identified in the query is utilized by
the healthcare management server computer to determine if the
healthcare services proposed to be performed by the healthcare
provider identified in the query are in compliance with the
healthcare treatment procedures.
28. The method of claim 25 further comprising the steps of a. the
healthcare management server computer obtaining insurance
information from a healthcare insurer computer and b. utilizing the
insurance information to determine if the parameters of the query
are in compliance with one or more of the predetermined compliance
rules.
29. The method of claim 28 wherein the insurance information
comprises information related to an insurance payment that the
healthcare insurance provider agrees to pay for the proposed
healthcare services.
30. The method of claim 29 wherein the insurance payment is made by
the healthcare insurance provider to the healthcare provider based
on the healthcare services rendered by the healthcare provider to
the patient.
31. The method of claim 25 wherein the compliance rules comprise
rules promulgated by a governmental agency.
32. The method of claim 25 wherein the compliance rules comprise
rules promulgated by a healthcare administrative agency.
33. The method of claim 25 further comprising the steps of: a. the
healthcare provider computer retrieving from the healthcare
management server computer healthcare information associated with
the patient and b. presenting the healthcare information.
34. The method of claim 25 further comprising the step of providing
a plurality of tokens, each of which is associated with a patient,
and each of which is encoded with the unique identification indicia
for identifying the associated patient.
35. The method of claim 34 wherein the token is a healthcare
card.
36. The method of claim 35 wherein the healthcare card is a card
comprising a magnetic stripe encoded with the patient
identification indicia.
37. The method of claim 35 wherein the card is a smart card
comprising storage means for storing at least the patient
identification indicia.
38. The method of claim 34 wherein the token is an RFID device
capable of subdermal implantation.
39. The method of claim 25 further comprising the steps of a.
entering revised healthcare information into means for inputting
data associated with the healthcare provider computers; b.
transmitting the revised healthcare information to the healthcare
management server computer; and c. modifying the record in the
repository associated with the patient to include the revised
healthcare information.
40. The method of claim 25 comprising the further step of providing
a third repository of health point account records associated with
each of the patients, the health point account records containing a
health point account that indicates a number of health points that
have been awarded to the patient based on one or more of a
plurality of health-related criteria.
41. The method of claim 40 wherein health points are awarded to a
patient for participating in a positive health-related
activity.
42. The method of claim 40 wherein health points are awarded to a
patient for not participating in a negative health-related
activity.
43. The method of claim 40 wherein health points are awarded to a
patient for maintaining a predetermined level of health.
44. The method of claim 40 wherein multiples of health points are
accumulated in the health point account.
45. The method of claim 40 wherein a patient may redeem accumulated
health points from the associated health point account in exchange
for one of a plurality of available benefits.
46. The method of claim 40 wherein the plurality of available
benefits comprise reduced insurance premiums.
47. The method of claim 25 further comprising the step of providing
a third party financial services entity interoperable with the
healthcare management server computer, said third party financial
services entity functioning to make payment to the healthcare
provider based on the healthcare services rendered by the
healthcare provider to the patient.
Description
CROSS-REFERENCE TO RELATED APPLICATION
[0001] This application claims filing priority of co-pending U.S.
provisional patent application Ser. No. 60/576,634, filed on Jun.
2, 2004.
BACKGROUND OF THE INVENTION
[0002] The present invention relates to the provision of medical
and related management and monitoring services, and in particular
to a centralized method and system for managing and monitoring
healthcare services, payments, costs, risks, quality control, and
performance measurement.
[0003] The healthcare industry today is a complicated and
fragmented system. People at different times require the services
of various types of healthcare providers, such as doctors, home
care nurses, dentists, surgeons, therapists such as physical
therapists and the like. People will utilize these services as
needed or on an emergency basis, or often on recommendations of
others. As a result, people will tend to use such healthcare
providers that have no relationship with one another, which results
in fragmented health care management. For example, a person may
have medical records on file with a general practitioner doctor, a
number of specialists, their dentist, etc. This can lead to
redundancy of paperwork, increased human error, which in turn can
lead to mistakes in providing care, for example when one healthcare
service provider does not have a complete record of a patient's
medical history and makes an incorrect diagnosis or recommendation
as a result. Mistakes can also occur when a patient visits a new
doctor and provides erroneous background information. Expenses are
driven upwards when healthcare service providers try to obtain
prior records such as x-rays, etc. in order to dispense treatment.
These issues also lead to delay in obtaining treatment. As a
result, many people will not seek appropriate medical treatment
(including preventative care and maintenance) because it is too
inconvenient, cumbersome, confusing, and time-consuming.
[0004] The patient-specific issues mentioned above are also
problematic from the viewpoint of the healthcare service provider.
In addition, the healthcare service provider is usually paid by a
health insurance company or other third party (such as a credit
union), which adds many more problems such as inordinate delays in
getting paid, increased paperwork, and even nonpayments in some
cases. This increases the cost of providing services and takes away
the providers' time that could otherwise be spent tending to their
patients.
[0005] Healthcare insurers also face problems such as insurance
fraud (for example where claims are made for services not rendered,
excessive testing, improper prescriptions, etc.) and the increased
cost of processing the insurance claims from the healthcare service
providers as well as patients.
[0006] Healthcare service centers such as hospitals, as well as
their patients, also face similar problems. Persons desiring to
obtain medical care, for example in an emergency situation, often
encounter long delays in getting appropriate treatment. Delays may
be attributed to several factors. One factor is the requirement for
a patient to fill out forms at the emergency room intake, including
personal information (e.g. name, address, telephone number), past
medical history, and insurance information. This type of
information is static since it generally does not change based on
the emergency at hand. Other information that must be provided is
situation-specific, such as the symptoms encountered by the patient
at the time of the particular visit to an emergency room or other
health care provider. Delays are further encountered when the
emergency room personnel must process the information provided by
the patient, such as when they must verify the validity of the
insurance information given.
[0007] Delays such as these can have significant consequences in
situations where care must be immediately provided. Even in those
non-emergency situations, long delays in obtaining appropriate care
is undesirable.
[0008] It is therefore desired to provide a centralized healthcare
management and monitoring service that interoperates with
subscribers to the service, who may be patients, healthcare
providers, healthcare institutions, governmental agencies,
pharmacies, pharmaceutical companies, and insurance companies, in
order to promote a patient's well-being, reduce their anxiety, and
generally to overcome these problems of the prior art.
[0009] It is a further object of the invention to provide such a
centralized healthcare management and monitoring service that can
manage all of the transactions between these parties to reduce
costs, increase speed of payment, and reduce if not eliminate
payment on fraudulent claims.
[0010] It is a further object of the invention to provide such a
centralized healthcare management and monitoring service that
reduces medical history management burdens by providing a
centralized repository of patients' medical histories that is
secure, easily accessed by authorized parties, and easily modified
as diagnoses are made and treatments are rendered.
[0011] It is a further object of the invention to provide such a
centralized healthcare management and monitoring service that
utilizes a portable token such as a healthcare card for identifying
carriers thereof as subscribers to the system, enabling for example
the patient/subscribers to receive priority health care in
conjunction with the system.
[0012] It is a further object of the present invention to utilize
the aforementioned healthcare card to quickly access the patient's
medical records from the repository, view the medical records, and
modify the medical records as authorized by the system.
[0013] It is a further object of the invention to provide a system
that enables aggregation or batching of products or services in the
healthcare field and thus provide efficient and cost-effective
treatment of patients.
[0014] It is a further object of the invention to provide a
centralized healthcare management and monitoring service that
provides monitoring of procedures, costs, payments, etc. to ensure
compliance with a variety of rules, regulations and medical
standards.
[0015] It is a further object of the invention to provide a
centralized healthcare management and monitoring service that
provides incentive to participants in the form of health
performance and reward points that may be earned for participating
in health-related activities and/or for maintaining a healthy
lifestyle, and which allows a participant to accumulate such health
points and redeem them towards a variety of awards such as reduced
insurance premiums.
[0016] It is a further object of the invention to reduce insurance
costs and reduce risks by implementing proactive procedures and
preventative and maintenance care activities.
SUMMARY OF THE INVENTION
[0017] The present invention is a seamless end-to-end solution
involving all participants, i.e. patients, health care providers
and institutions, and insurance companies. The present invention is
a centralized healthcare management and monitoring system and
service that includes several main components operating over a
computer network such as the Internet. A healthcare management
server computer is interconnected to the computer network, and
includes a first data repository of patient records, each patient
record associated with a patient who is a subscriber to the system
and accessible via a unique patient identification indicia
associated with the patient, each patient record comprising
healthcare information associated with the patient. A second data
repository includes sets of predetermined compliance rules, each of
the compliance rules having information regarding an interaction
between multiple entities associated with the healthcare management
server computer. For example, a compliance rule might state that a
pregnant woman should have a sonogram procedure in the fifth month
of pregnancy.
[0018] A plurality of healthcare provider computers is also
interconnected to the computer network, each of which is associated
with a healthcare provider such as a doctor who is a subscriber to
the system. Each of the healthcare provider computers has means for
inputting a patient identification indicia presented by a patient
and communicating with the healthcare management server computer
over the computer network using the patient identification
presented by the patient. Thus, when a patient presents, in
association with healthcare services performed by the associated
healthcare provider, a patient identification indicia associated
with the patient, the healthcare provider computer transmits to the
healthcare management server computer a query including the
following parameters: the patient identification indicia; an
identification of the healthcare services performed or proposed to
be performed by the associated healthcare provider; and an
identification of the healthcare provider performing the healthcare
services. The healthcare management server computer then utilizes
the query to access the first and second data repositories to
determine if the parameters of the query are in compliance with one
or more of the predetermined compliance rules.
[0019] For example, the compliance rules may be related to
healthcare treatment procedures, and the healthcare management
server computer determines if the healthcare services proposed to
be performed by the healthcare provider identified in the query are
in compliance with the specified healthcare treatment procedures.
In addition, the healthcare information associated with the patient
identified in the query may be utilized by the healthcare
management server computer to determine if the healthcare services
proposed to be performed by the healthcare provider identified in
the query are in compliance with the healthcare treatment
procedures as adapted for that particular patient.
[0020] In a further embodiment, a healthcare insurer computer
associated with a healthcare insurance provider may also be in
communication with the healthcare management server computer,
either directly or via the computer network. The healthcare
management server computer obtains insurance information from the
healthcare insurer computer and utilizes the insurance information
to determine if the parameters of the query are in compliance with
one or more of the predetermined compliance rules. The insurance
information may include information related to an insurance payment
that the healthcare insurance provider agrees to pay for the
proposed healthcare services. The insurance payment may be made by
the healthcare insurance provider to the healthcare provider based
on the healthcare services rendered by the healthcare provider to
the patient.
[0021] In addition to specific patient treatment guidelines, the
compliance rules may include rules promulgated by a governmental
agency, or by a healthcare administrative agency.
[0022] Thus, accountability to standards of care and compliance
with existing rules is enabled by the present invention and
essentially forced on participants to the system.
[0023] A token may be used to encode the unique identification
indicia for identifying the associated patient. Typically, the
token may be in the form of a healthcare card, which may have a
magnetic stripe encoded with the patient identification indicia, or
which may be a smart card comprising storage means for storing at
least the patient identification indicia. The token may also be an
object such as RFID device capable of subdermal implantation. Other
subscribers such as doctors may carry healthcare cards encoded with
indicia identifying them as subscribers to the healthcare
system.
[0024] The healthcare provider computers may comprise means for
inputting data, such as keyboards, scanners and the like, wherein
revised healthcare information is entered into the healthcare
provider computer and transmitted to the healthcare management
server computer, and the record(s) in the data repository
associated with the patient are modified to include the revised
healthcare information.
[0025] In another aspect of the invention, the healthcare
management server computer may include or have access to a third
data repository of health point account records associated with
each of the patients, the health point account records containing a
health point account that indicates a number of health points that
have been awarded to the patient based on one or more of a
plurality of health-related criteria. For example, health points
may be awarded to a patient for participating in a positive
health-related activity (such as joining a health club), or for not
participating in a negative health-related activity (such as
smoking). Health points may also be awarded to a patient for
maintaining a predetermined level of health (such as being at a
goal weight or having exemplary blood pressure).
[0026] Multiples of health points may be accumulated in the health
point account, and a patient may redeem accumulated health points
from the associated health point account in exchange for one of a
plurality of available benefits such as reduced insurance
premiums.
BRIEF DESCRIPTION OF THE DRAWING
[0027] FIG. 1 is an illustration of the healthcare management and
monitoring system of the preferred embodiment of the present
invention;
[0028] FIG. 2 is an illustration of the healthcare management
server of FIG. 1; and
[0029] FIG. 3 is an illustration of the query sent to the
healthcare management server of FIG. 1.
DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENT
[0030] The present invention is a method and system for providing
priority-based healthcare management and monitoring services to
various subscribers of the system. A subscriber may be a patient, a
healthcare provider such as a doctor, a healthcare institution such
as a hospital, an insurance company, or a governmental agency. As
shown illustratively in FIG. 1, the system 2 implements a
centralized health care management server computer 4 that manages
interactions amongst patients 6, health care providers 10 (such as
doctors, therapists, dentists, as well as non-licensed caregivers),
health care institutions 8 (such as hospitals), and the health
insurance companies 12. In particular, the healthcare management
server computer 4 is an intermediary between these parties in
accordance with the transaction being executed. For example, when a
patient requires emergency room treatment, the healthcare
management server computer 4 will be a liaison between the patient
and the health care institution, between the health care
institution and the insurance company, between the patient and the
health care provider, etc. These interactions are explained in
further detail herein.
[0031] In addition to being a liaison between the above parties for
such transactions, the healthcare management server computer 4
provides a centrally located medical and insurance data repository
that can be accessed by all authorized parties in order to easily
ascertain a patient's medical history, for example. As described
herein, this medical record repository provides a streamlined
methodology for ensuring that medical information is accurate,
timely, and easily accessed and revised.
[0032] A person may become a member of the system 2 by subscribing
to the services offered to consumers by the health care management
server computer 4. That is, with respect to consumers, the system
is subscription based, wherein a consumer becomes a patient
subscriber by paying an enrollment and/or periodic membership fee
and/or transaction fee to the healthcare management service 4,
which may be operated by the insurance company, medical practice,
or other financial or other services entity. The patient will
register with the healthcare management service 4 either directly
or via a participating health care institution 8 (such a local
hospital), or via a participating health care provider (such as the
family doctor), or via their health insurance company 12. Once
registered with the system 2, it may be preferred for the patient 6
to always use the priority services of his local health care
institution 8 but is also able to use the priority services of
other health care institutions 8. For example, the patient may
chose at any given time to use a different health care provider, or
if the patient is traveling he may be required to use a different
health care provider.
[0033] In addition to individual patients subscribing to the
system, families of subscribers are also contemplated to enroll.
Data may be collected, stored and analyzed for these families
(natural, extended or otherwise) to help in providing appropriate
diagnosis, treatment, etc. Furthermore, geocentric components of a
subscriber may also be logged in order to analyze location-based
indicia such as high occurrences of an environmentally effected
disease (e.g. breast cancer). Detailed analysis of location based
patient data can help to uncover risk factors and develop treatment
plans accordingly. Also, these data can lead to intelligent
predictive analysis that can be stored in patients' profiles in the
database 14.
[0034] The present invention allows integration and analysis of
patient data such that candidates for research projects may be
selected from the database based on various criteria of the
project. For example, a need for sleep-deprived subjects in a
medical study may be met be simply querying the databases of the
management server to find patients with that characteristic.
[0035] The health care management service may operate in the
financial services area as a factor or guarantor of payments to all
members and subscribers of the system. A third party financial
services institution may be a part of the system and function as
the payor for products and services administered under the system,
as an adjunct to or in the alternative to typical insurance
companies. Also, the present invention may operate on behalf of a
self-insured entity in a closed or open environment.
[0036] A health care institution 8 such as a hospital may in some
situations be the focal point of the value-added or extension
services in this invention. For example, a hospital may already be
setup to offer standard hospital services, such as emergency room
care, surgical services, and general health care. Other extension
services may be added, such as maternity care, neo-natal care,
dentistry, orthodontia, etc. By forming alliances based on the
hospital as the core service provider, the system achieves a
synergy advantageous to patients as well as the health care
providers 10 as described herein. Notably, independent health care
providers may be incentivized to make alliances with a health care
institution 8 under this system.
[0037] The hospital will implement computers that will interconnect
to a central health care management server computer 4, which will
manage the system of the present invention. The health care
institution server 8 will provide value-added services as an
application layer on top of existing health care
provider/patient/insurer relationships. The health care management
server 4, in addition to being interconnected to various hospital
client computers, will also be interconnected to insurance server
computers 12 operated by the health insurance companies. Thus, the
health care management server 4 will act as a liaison between the
hospitals and the insurance companies as described herein.
[0038] Each hospital will provide offers to users to become members
of the network by paying an initial membership fee and filling out
various forms that require input of personal information, medical
history, insurance information, etc. This information may be input
in various electronic forms available from the hospital via a web
server over the Internet, or the patient may fill out paper forms
and submit them to the hospital, which will enter the data directly
or forward the forms to the health care service provider for entry.
In the alternative, certain information such as existing insurance
information may be automatically be accessed by communications with
the insurance companies and used for this health care card. In any
event, each patient will have their required information (personal,
medical, insurance) entered into a central repository at the
central healthcare management server. In addition, information such
as DNA information may be included in the database of patient
information for subsequent identification and/or analysis
purposes.
[0039] After the patient becomes a subscriber to the system and
provides the required information, then the system 2 will issue a
membership card or other token to the patient, which may be in the
form of any type of card known in the art such as a magnetic stripe
card, a card having a bar code or RFID chip, a smart card, a stored
value card, etc. The card will have basic information encoded
thereon, such as a patient identification number. The
identification number may be any indicia that uniquely identifies
the patient, such as any arbitrary indicia or even the patient's
unique Social Security number, which will allow integration with
other databases that utilize the Social Security number. When the
patient wishes to use the card, he presents it to a terminal at the
hospital, and the appropriate card reading technology will be
employed to read the identification number off of the card.
[0040] Thus, when a patient 6 requiring medical services presents
the card to a terminal at the affiliated health care provider 10 or
healthcare institution 8, the card will be read (and PIN, or other
identification such as a password or biometrics, entered if
desired) and the patient identification number will be transmitted,
via a network connection such as the Internet, from the health care
terminal to the health care management server 4. The healthcare
management server 4 will use the identification number to look up
the pertinent information for that patient from the data repository
of patient records 14 (see FIG. 2) and interact with the health
care institution server and/or insurance server as may be required,
as further described herein.
[0041] The health care management server 4 may store in patient
database 14 current insurance information for each of its patients,
which may be updated periodically as desired (e.g. weekly, daily,
etc.) In the alternative, the health care management server 4 may
communicate with the appropriate insurance company 12 in real-time,
as needed by the system to determine the scope of the coverage and
get approval for treatment, if necessary. It also may be determined
if human interaction or intervention is required. For example, if a
patient requires an immediate emergency operation, then the health
care management server 4 would query the insurance server 12 to
ascertain the coverage amounts, as well any other pertinent
information. A real-time query might provide greater accuracy of
information than use of a local database at the health care
management server.
[0042] Thus, all of the required insurance information as well as
personal information and medical history information is retrieved
from the patient repository 14 and sent from the health care
management server to the health care institution (hospital)
computer 8 or healthcare provider computer 10. There, online forms
will be populated with the required data and all of the information
will appear in the screen of the terminal being used at the
hospital. Rather than having to manually enter each piece of
information, the process provides for automatic input from the
health care management repository 14, which provides for greater
accuracy and increased speed. Records such as X-ray prints and the
like may be digitized and stored digitally in the repository 14,
and thus be accessible to anyone with a need to access them. A fee
may be charged to the requesting party for transmitting them; for
example, it may cost $20 to provide a set of x-rays that were taken
in the past year of a healing bone fracture. These records would be
immediately accessible to any authorized party for the specified
fee, which may be charged and paid for by the appropriate payee
(e.g. the insurance company). A patient is also able to access his
medical information in this manner in a simple and efficient
process. The patient may be able to access a web server at the
healthcare management computer 4, enter his patient ID number, and
then access his medical history accordingly.
[0043] Other benefits are provided to a patient of this priority
care system. Since patient screening and intake is reduced
substantially, the emergency room personnel can process the patient
much faster and are able to provide expedited entry into a
screening room, where they will receive the required medical
attention. This service may also provide for tiered services,
wherein certain patients (e.g. those paying a higher premium) will
receive care prior to non-subscribers, as long as the
non-subscriber is not in a life-threatening situation. This
provides an incentive for patients to subscribe to the system since
they will move to the head of the line faster than those who are
not subscribers. This benefits hospitals since they can process
these patients faster due to the automated data retrieval and form
population.
[0044] By issuing priority health care cards as described herein,
the hospital may be co-branded with the central service provider.
Thus, a patient may have a "St. Luke's Hospital PRIORITY CARE Card"
or the like, designating their primary hospital for health care
services. This will immediately identify the patient as belonging
to that primary hospitals' service upon entry to the emergency
room. Different member hospitals would enter into agreements with
each other and/or the central service provider to allow patients to
use other hospitals (secondary hospitals) if necessary (e.g. while
traveling), and the same information would be retrieved for that
secondary hospital since they utilize the same system, forms, etc.
Rules may be established wherein subscribers at secondary hospitals
are given priority treatment over non-subscribers, but not over
those subscribers at that hospital.
[0045] Revenue may be generated on a subscription basis, wherein a
subscriber pays a periodic or one-time fee for being a member of
the system. For example, a patient may pay a $20 yearly fee, or a
doctor may pay a $500 one-time fee, etc. Likewise, transaction fees
may be imposed by the healthcare management service, which may or
may not be paid by the insurer.
[0046] The monitoring service of the present invention may now be
described. In addition to storing the first data repository of
patient healthcare records 14 as mentioned above, the healthcare
management server computer has additional data repositories that
store compliance information and rules 16, health point accounts
18, and healthcare provider records 20. The compliance rules are
related to interactions between the multiple entities associated
with the system, i.e. the patients, insurers, healthcare providers
and institutions. The compliance rules may be based on information,
rules and regulations promulgated by one or more various
institutions, such as a healthcare insurance company, a
governmental entity, etc. The compliance rules may set forth
predetermined standards of care, such as standards of care for a
pregnant woman (e.g. how many physician visits are appropriate, and
at which intervals, which test should be administered and when,
etc.). The compliance rules may also set forth standards of payment
promulgated by an insurance company, such as which treatments are
covered for particular ailments, etc. The compliance rules may
encompass any predetermined standard, rule or regulation as may be
applicable in the healthcare industry.
[0047] The monitoring service of the present invention will utilize
some or all of the predetermined compliance rules in order to
evaluate a proposed course of treatment or the like. Thus, when a
patient presents his identification card to a healthcare provider
such as a doctor, the healthcare provider will swipe the card into
a terminal connected to a healthcare provider computer 10 located
in proximity to the doctor's office. The patient's identification
indicia will be read off of the card and a query 22 will be
formulated by the healthcare provider computer. The query, as shown
in FIG. 3, will be composed of the following components: [0048] the
patient identification indicia 24 as read off of the healthcare
card (or other like token) [0049] a description or other
identification (e.g. code) 28 of the healthcare services that are
being proposed to be administered by the healthcare provider or
which have already been administered (such as a sonogram for a
pregnant woman) [0050] an identification 26 of the healthcare
provider (e.g. the doctor's subscriber/ID number)
[0051] Optionally, other information may include the healthcare
institution that may be involved (e.g. the name of a clinic or
hospital),and other pertinent information regarding the condition
of the patient. The query will thus at least have information that
indicates who is about to administer a procedure, what the
procedure is, and on whom the procedure will be administered (e.g.
Dr. John Smith will perform a sonogram on Mrs. Mary Doe, who is in
her fifth month of pregnancy).
[0052] The query 22 will then be transmitted by the healthcare
provider computer 10 to the healthcare management server 4 computer
over the computer network (i.e. the Internet). The healthcare
management server computer 4 will receive the query 22 and then
access the data repositories 14, 16, 18, 20 by using the query
information. The healthcare management server computer 4 will in
particular access the compliance rules 16 mentioned above to
determine if the proposed course of treatment is acceptable under
the circumstances. If the proposed treatment is in fact in
compliance with the predetermined standards, then this will
generate an approval message which will be transmitted back to the
healthcare provider computer 10 and also stored in transaction log
21 for future reference. The healthcare provider will be informed
that the proposed procedure has been approved and may then proceed
as planned.
[0053] The insurance server computer 12 may also be included in
this process to ensure that payment may be made on a timely basis
by the insurance company to the healthcare provider. Once the
process has been approved, then there is an assurance to the
healthcare provider that payment will be made. The process may be
completed when the healthcare provider indicates that the procedure
has been administered, which may be confirmed by the patient as
well. In addition, the patient may be asked to approve payment or
may be asked to respond to an exit survey regarding the services
rendered.
[0054] In another aspect of this invention, a health performance
points program may be established by use of the healthcare card. A
schedule will be generated that sets forth certain health related
tasks, such as a yearly dental check-up, and an associated number
of health points that would be awarded to a patient who completes
that task. These tasks would promote well-being, including but not
limited to dental check-ups, prostate examinations, breast
examinations, vitamin purchases, cholesterol review, etc. The tasks
would be based on a profile of requirements of the insurer or other
participating entity. By awarding these health performance points,
and tracking them via the healthcare card, the patient is
incentivized to perform these tasks since they can be used to earn
broader insurance benefits, discounts, or to reduce costs. In
addition to the tasks mentioned above, health performance points
may be awarded to individuals based on actual performance data.
Thus, points may be awarded as a function of the patient's weight,
in which patients at a goal weight would receive more points than
someone who is overweight. Likewise, non-smokers would get points
whereas smokers would receive no points or even have points
deducted. Health points would be tracked in a health point account
database 18 as shown in FIG. 2.
[0055] As mentioned, a patient that has reached a predetermined
milestone of accumulated health performance points may receive
favorable rates on health insurance premiums, since healthier
patients (as measured by their accumulated health points) generally
translate to lower insurance costs. Likewise, doctors and other
health care providers may have their patients' reward points
tracked so as to determine those doctors with healthier patients,
at least as determined by their accumulated health point totals.
Doctors with larger numbers of patients having more health points
will be rewarded with health performance points of their own based
on their patients' performances, and then by being provided with
lower malpractice insurance costs based on a premise that a
healthier patient will be less likely to require medical attention
and thus less likely to be subject to medical procedures that are
accompanied by risk of malpractice. This premise may be extended to
hospitals that have doctors with relatively higher amounts of
health performance points (based in whole or in part on their
patients' point totals), which will then also receive lower
insurance rates.
[0056] Thus, this health performance point system will provide a
mechanism for risk management, by allocating lower costs of
participation to those who can objectively demonstrate their lower
risk factors via accumulation of health performance points.
[0057] An authorized subscriber, after logging in, may be given
access to various data over the Internet by interconnecting with
the central server database, and can modify the data as needed. In
addition, the subscriber may be given a menu of plan options that
may be reviewed and selected as desired. For example, a
multi-tiered set of services may be offered (e.g. silver, gold,
platinum), and the patient may choose or modify the desired plan.
Payment may easily be made by any means known in the art, including
but not limited to credit card, smart card, debit card, stored
value card, or check.
[0058] The patient may also be able to access various accounts via
his priority care card, such as insurance accounts, and modify
those accounts online. For example, by using his card to access his
patient profile, the patient may be able to increase the amount of
insurance he has (health, but also possibly automobile, life,
property, etc.) in a given situation. A waiting period may be
established before the modified insurance would be accepted, for
instance to verify any changes in conditions of the insured
party.
[0059] The present invention operates over a network (or set of
independent networks) as illustrated in FIG. 1 that interconnects
the various parties mentioned herein. In one embodiment, the
approval and payment processes operate over a separate network that
may piggyback the existing credit card infrastructure and operate
in a similar manner, wherein parties request and obtain approval
for health transactions in the same manner that banks interoperate
over the credit card network. A separate information network, such
as the Internet, could also be utilized to interconnect the various
entities to provide information flows therebetween, such as when a
patient logs onto the system to access his medical records. In
another embodiment, a single network such as the Internet may be
used to accomplish all functionality if desired.
[0060] The patient's profile, as stored at the health care
management repository 4, may have various levels of access
proscribed in order to provide desired levels of privacy to the
patient. For example, there may be three levels of access defined;
highly confidential, moderately confidential, and non-confidential.
The fact that a patient may have a disease such as AIDS may be
classified as highly confidential, but his blood type may only be
classified as non-confidential, etc. Then, in a given situation,
rules would be defined that would allow certain persons access to
only the non-confidential information, for example, and not the
highly confidential information. Each health care provider or
authorized person would have a security level assigned to them, and
they would be required to enter their ID code at the time
information is requested. The patient profile and rules would
determine which information that person should have access to, and
transmit only that information accordingly. These rules may be
modified in emergency situations, which are also defined by
predetermined rules.
[0061] The subscriber may also enter the names and contact
information for emergency contact persons, such as a spouse,
parent, or child. This can also easily be modified at the central
server web site in patient database 14. When a patient presents the
card to the emergency room at the hospital, the emergency contact
information will be retrieved from the central server database 14
and the hospital may use this information to manually or
automatically contact the designated person. For example, a patient
may specify that in the event of an emergency room visit, certain
people (such as his spouse and parents) must be notified, and their
contact information is provided. The specific persons contacted may
depend on the level of the emergency, e.g. his parents are only
notified in an extreme emergency, or if his spouse cannot be
reached. The central service or a third party may be utilized to
perform these services as well. Other events may be triggered well.
For example, in the event that a person is admitted to a hospital,
the patient's profile may indicate that the local post office
should be contacted to halt mail delivery, the news carrier should
likewise be contacted to halt newspaper delivery, etc. This is
particularly useful for those living alone, such as the elderly,
who would not have someone at home that could take care of these
events.
[0062] The storage facility at the healthcare management server 4
is designed to be especially secure and robust, given the
confidential nature of the data being stored, accessed and revised.
Certain governmental regulations have been promulgated to ensure
data integrity and data storage safety and security, and the
present invention complies with such regulations.
[0063] Value-added services could also be instituted and triggered
by events as indicated in a patient's profile. A further example
would be a service that provides meals to the elderly or
infirm.
[0064] By utilizing the present invention, payments may be made in
an expedited fashion to the health care providers and health care
institutions. The healthcare management service may opt to provide
quick payment to the recipients in exchange for an agreed-to
discount, which may be on a sliding scale. For example, the
management service may provide next day payment in the amount of
92% of the fees, with the remaining 8% being retained as a
transaction fee. That is, on a $1,000 bill that would be covered by
insurance, the management service would pay the recipient $920 the
day after the service is rendered. The management company would be
assigned to the right to collect the full payment from the
insurance company ($1,000) and would retain the $80 difference as a
transaction fee. Payment may not be made by the insurance company
for a prolonged period of time, but this is what the transaction
fee is intended to account for. The percentage may change as a
function of delay in payment, so for example if the recipient is
willing to receive payment from the management service one week
later rather than one day later, they may get 94%, or if they take
payment one month later they may receive 96%, etc. Other
alternatives may be used, such as providing certain discounts based
on volume, or on a sliding time scale, etc. These terms of payment
would be agreed to by the parties contractually. The health care
providers may indicate in a profile, for example at registration,
their preferred form of payment, which may be modified as specified
by the system.
[0065] This invention solves various problems for all of the
parties that interact in the current medical care environment.
Doctors and other health care providers will benefit by obtaining
payment for their services in a timely manner, and by having
reduced paperwork and operating costs. Patients will no longer
suffer from lack of information about their past and current
medical conditions as well as future requirements, and the lack of
timely, attentive services in this area. Insurers will be able to
obtain better records, patient and doctor information, and
accounting records, and will be able to enforce rules and manage
providers and patients better in order to reduce risks and their
attendant costs.
[0066] In one embodiment, card reading terminals may be
strategically located at various physical locations at a given
health care institutions or premises of health care providers, The
patient may be required to swipe his priority care card upon
entering an examination room, for example, in a doctor's office.
The doctor may also be required to enter his ID code into the
system upon starting and ending the treatment. Thus, the health
care management server would have a record of when the patient
received his treatment. This information may be used to combat
fraudulent claims, for example if a health care provider makes a
fraudulent claim that a patient visited his office for treatment on
a day when there is no log of such visit according to the terminal
data. Furthermore, once the patient swipes his card into the
reader, his medical records may be retrieved from the repository 14
and made available to the doctor in the examination room. This
would expedite treatment since, by the time the doctor actually
enters the examination room to make an analysis and dispense
treatment, the medical records would be displayed on a screen of a
networked computer. The doctor would use that information during
his analysis, and then may be able to enter modified data to update
the medical records 14 in accordance with the treatment being given
at that time.
[0067] Any type of device that will enable a user to interconnect
to the system, enter data and receive information back from the
healthcare management server may be used in addition to computers
as shown in the Figures. Thus, handheld wireless devices such as
cell phones, PDAs, etc. are envisioned to be interoperable with the
system of the present invention.
[0068] In a further embodiment, the doctor may make a drug
prescription while the patient is being treated and enter it into
his computer, which would be uploaded into the patient's file 14 at
the central data repository. This prescription may then be
automatically downloaded to a pharmacy previously designated by the
patient, where the pharmacist would be able to prepare the
medication for pickup by the patient upon presentment of the
priority care card. In the alternative, the prescription would be
held at the healthcare management server and then when the patient
arrives at any participating pharmacy and presents his priority
care card, the prescription would be retrieved and fulfilled.
[0069] This also provides for the ability to keep track of the
usage of pharmaceuticals and other medical supplies, and enable an
automatic or semi-automatic ordering system whereby supplies that
are tracked via the system as being in low supply are ordered and
restocked accordingly.
[0070] The present invention provides for marketing of products and
services by participants. For example, a health care provider that
administers prenatal care to a patient would be able to market
appropriate products to that patient either at the time of
treatment or before or afterwards.
[0071] In addition to the parties mentioned herein, other third
party providers that are not subscribers to the system may be
enabled to plug-in and interoperate with the system as long as
certain security constraints are adhered to. Payment mechanisms
would be employed to ensure that such non-registered third party
participants make appropriate financial payments in exchange for
interoperating with the system.
[0072] As previously mentioned, the priority care card may be in
the form of a magnetic stripe or bar coded card, in which case the
information embedded in the card would be minimal--likely only an
identification number and/or name--and the patient's information,
medical records, profiles, etc., would all be kept at the central
repository 14. The card would be used to access all of the
pertinent information as well known in the art. In an alternative
embodiment, a smart card or stored value card may be used, which
advantageously carries memory and/or processing circuitry as known
in the art. In this case, much more information may be carried by
the card for local applications where the central repository is not
easily accessed. Furthermore, the data stored on the card may be
modified by the local terminal in accordance with the application
parameters. For example, it would be possible to store health
reward points, previously mentioned, in memory on the card rather
than at the central repository. Thus, in the event that the card is
used with applications that are not interoperable with the central
server of this system, but which accept reward points as a
universal currency, then the off-network application could use the
reward points as currency for making purchases or achieving better
benefits. That is, the local application could access the reward
point account, make appropriate deductions (or additions), without
having to contact the central server.
[0073] Another feature of the present invention provides for a
medical audit process for patients. Each patient may have their own
personal web page stored in database 14 at the health care
management server, which may be accessible via any web browser
after an initial log-in process. There, the patient may view all of
his medical and insurance information, including but not limited to
prior medical events (such as checkups, treatments, diagnoses, drug
prescriptions, test results), insurance information (such as
policies, claims made and status thereof, contact information),
medication information such as expiration dates, etc. There will
also be a timetable or schedule (a "medical calendar") of
recommended treatments that sets forth the various procedures
recommended for that patient, such as prostate screening at age 45,
etc. This may be generated in conjunction with the compliance rules
in database 16. This will greatly enhance the patient's ability to
manage his medical and insurance information in one centralized
location. The patient will also be able to make changes in his
policy coverage by interacting with the web server, which in turn
will interact with the interconnected insurance companies as
requested.
[0074] The present invention provides for a web site to be
established at the healthcare management server that will enable a
patient to view provider listings and obtain information regarding
the various healthcare providers and institutions that are part of
the system. The managements server can present information such as
referrals, ratings, recommendations, qualifications, and the like,
which will enable the patient to make informed decisions regarding
their choice of healthcare provider based on this information.
Thus, a patient may be able to determine that certain doctor is
highly recommended for certain procedures but not for others. This
also enable cost comparisons, which may be especially useful if the
patient must pay for an appreciable part of the treatment (such as
with deductibles, co-payments, etc.).
[0075] The health care card of the present invention and system
with which it operates contemplates the integration with biological
depositories such as blood banks, tissue banks, etc. The system may
integrate with these entities so that a patient may for example
make a blood donation and simply present his card to a terminal at
the time of the blood donation. By identifying the person via the
card, the system can look up the relevant data from the healthcare
management server 4 such as name, blood type, and disease history.
As long as that person shows no diseases on file that would deter
the blood bank from accepting his blood as a donation, then the
blood extraction proceeds. If however that person's medical history
reveals a disease such as AIDS, then the operator will be alerted
to that fact and the blood will not be accepted.
[0076] When a person makes a donation under this embodiment, the
donation will be noted on his account. Health reward points may be
awarded and added to the patient's account in database 18 for the
blood donation. The blood itself that is donated may also be
tracked to that person via his identification card. The information
may be stored on the central server and accessed via identification
of the card presented, or the data may be stored on the card itself
and updated accordingly, such as with a stored value card, a smart
card and the like.
[0077] A further embodiment of the system provides for an
implantable token such as a subdermal implant that is encoded with
information that links to the system in the same manner as the
health care card previously described. By using an appropriate
reader, the health care provider may quickly ascertain the medical
history, records etc. of the carrier without requiring them to
physically present the card. This is quite useful in emergency
situations, such as in a battlefield, where the wounded patient is
unable to speak with the doctor or present his card. In the event
that the patient has no wallet or other means of carrying a card,
the subdermal implant will link the doctors to the same information
stored in the system.
* * * * *